Provider Demographics
NPI:1740248897
Name:TAIT, JEFFREY (MBBS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:TAIT
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SWEETEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-255-0231
Mailing Address - Fax:828-277-3385
Practice Address - Street 1:68 SWEETEN CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-255-0231
Practice Address - Fax:828-277-3385
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23443207Q00000X
NC23447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8981419Medicaid
NC210829BMedicare ID - Type Unspecified
NC8981419Medicaid